One code, one chance, one 12 month window. How the IPPE works and how it fits with the wellness visits that follow it.
The Initial Preventive Physical Examination is Medicare's one time welcome visit: a review of medical, family, and social history, risk factors for depression and safety, functional ability, a focused examination including height, weight, blood pressure, BMI, and visual acuity, education and counseling, and a written plan or checklist of the screenings the patient is due for. It must happen within the first 12 months of Part B enrollment; after that window closes it is gone, and the patient's next preventive milestone is the Annual Wellness Visit.
| G0402 (IPPE) | G0438 / G0439 (AWV) | |
|---|---|---|
| Window | First 12 months of Part B only | After the first 12 months |
| Frequency | Once per lifetime | G0438 once, then G0439 yearly |
| Exam | Focused physical exam required | No exam beyond vitals required |
| wRVU | 2.60 | 2.60 / 1.92 |
The 12 month wall matters in both directions: G0402 is not payable after the first year, and G0438 is not payable within 12 months of a G0402. A screening electrocardiogram, once, may accompany the IPPE when ordered from it, reported with G0403 (complete), or G0404 and G0405 when tracing and interpretation are split.
As with the AWV, a medical problem genuinely evaluated at the same encounter is separately reportable with modifier 25 on the office visit code, with its own assessment and plan.
Quick answer on the wellness codes themselves: G0438 vs G0439. The full chapter is Medicare Annual Wellness Visits.